Milovanov Vladimir, Sardi Armando, Studeman Kimberley, Nieroda Carol, Sittig Michelle, Gushchin Vadim
Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA.
Ann Surg Oncol. 2016 Jun;23(6):1928-33. doi: 10.1245/s10434-015-5047-5. Epub 2015 Dec 29.
We evaluated the 7th edition of the American Joint Committee on Cancer (AJCC) staging classification in terms of overall survival (OS) in patients with PMP treated with cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC).
A total of 208 PMP patients treated with CRS/HIPEC were identified from a prospective database. Patients with peritoneal mucinous carcinomatosis (PMCA) were retrospectively staged at time of diagnosis according to AJCC staging classification. Patients with disseminated peritoneal adenomucinosis (DPAM) were evaluated in a separate group.
Median follow-up was 5.2 years. Of 208 patients, 124 had PMCA and 84 patients had DPAM. According to the AJCC staging classification 47 lymph node (LN) negative patients with well-differentiated PMCA, were classified as a stage IVA. 77 patients with either moderately or poorly differentiated PMCA irrespective of LN status, or well-differentiated PMCA with positive LN were classified as stage IVB. 84 patients with DPAM, constituted a separate group. OS of stage IVA and IVB patients was 100, 90, 67, and 91, 50, and 27 for 1, 3, and 5 years, respectively (p < 0.001). OS of DPAM patients was 96, 90, and 88 % for 1, 3, and 5 years, respectively (p = 0.025 comparing to IVA). PFS was estimated for IVA and IVB PMCA patients who were considered disease free after CRS/HIPEC and was 78, 52, and 43 % in the IVA patients and 65 %, 15 %, and 0 in the IVB group at 1, 3, and 5 years, respectively (p = 0.004). The adjusted HR for AJCC stages (IVA/IVB) was 3.7 (95 % confidence interval 2.0-6.7) (p < 0.001).
The 7th edition of the AJCC staging classification is a simple, reproducible, and valid classification for staging patients with PMCA undergoing CRS/HIPEC.
我们依据接受减瘤手术（CRS）/腹腔内热灌注化疗（HIPEC）治疗的腹膜假黏液瘤（PMP）患者的总生存期（OS），对美国癌症联合委员会（AJCC）第7版分期分类进行了评估。
从一个前瞻性数据库中识别出208例接受CRS/HIPEC治疗的PMP患者。腹膜黏液腺癌（PMCA）患者在诊断时根据AJCC分期分类进行回顾性分期。播散性腹膜腺黏液瘤（DPAM）患者在一个单独的组中进行评估。
中位随访时间为5.2年。208例患者中，124例患有PMCA，84例患有DPAM。根据AJCC分期分类，47例淋巴结（LN）阴性且高分化PMCA患者被分类为IVA期。77例中分化或低分化PMCA患者（无论LN状态如何）或高分化PMCA伴LN阳性患者被分类为IVB期。84例DPAM患者构成一个单独的组。IVA期和IVB期患者1年、3年和5年的OS分别为100%、90%、67%以及91%、50%、27%（p<0.001）。DPAM患者1年、3年和5年的OS分别为96%、90%和88%（与IVA期相比，p=0.025）。对CRS/HIPEC后被认为无疾病的IVA期和IVB期PMCA患者进行无进展生存期（PFS）评估，IVA期患者1年、3年和5年的PFS分别为78%、52%和43%，IVB组分别为65%、15%和0（p=0.004）。AJCC分期（IVA/IVB）的校正风险比为3.7（95%置信区间2.0 - 6.7）（p<0.001）。
AJCC第7版分期分类对于接受CRS/HIPEC的PMCA患者分期而言是一种简单、可重复且有效的分类方法。
